incessant, while the chest was filled with sibilant and sonorous râles in both back and front. There was also marked fever, the temperature reaching 102°8 on the morning of 1st June. This condition fortunately has disappeared as rapidly as it occurred. In describing the progress of the case to his clinical class, Dr. Cameron remarked that he was very familiar with the acute exacerbation of bronchitis occurring in those who were subject to the chronic form of the ailment as an immediate result of surgical injury. They had themselves lately had the opportunity of seeing one or two such cases in his wards; notably an old man, upwards of seventy, long a sufferer from chronic bronchitis, who, the day after admission, with a simple fracture of the humerus, was seized with an acute attack of the disease which quickly proved fatal.

EPITHELIOMA OF SCROTUM IN A PARAFFIN WORKER (“PARAFFIN CANCER.")-It is now a rare event to meet with a case of epithelioma of the scrotum in the chimney-sweep, at all events in the practice of the Royal Infirmary, although the disease has always been associated with that particular trade in surgical writings, since Percival Pott, in his well known work, stated that "there is a disease peculiar to a certain set of people, which has not, at least to my knowledge, been publicly noticed; I mean the chimney-sweepers' cancer." It is not, however, so well known that the workmen in the modern industry of paraffin-refining are equally obnoxious to the same ailment. The following is an example of this fact.

J. M., æt. 46, labourer in a paraffin work, was admitted on 20th May with a large epithelioma of the scrotum, which he first noticed twelve months ago. Dr. Cameron removed it on the 27th May, and succeeded in doing so without opening the right tunica vaginalis over which it was situated, but fortunately without any very close adhesion. The patient is progressing satisfactorily, the wound being now nearly healed. He has several small warts on the inside of his thighs, and one of considerable size on the back of his right hand. This latter is tending to ulcerate and will be excised before his dismissal. This is the third case of the kind that has come under Dr. Cameron's observation, but those medical men who have direct relations with such artisans (notably Dr. Longmuir of Bathgate) appear to have been long familiar with this affection.

Dr. Cameron showed a specimen of the disease at one of the earliest meetings, after its institution, of the Glasgow Pathological and Clinical Society.

CASE OF IRREDUCIBLE INGUINAL HERNIA: SUCCESSFUL TREAT

MENT BY MEANS OF THE ELASTIC BANDAGE.-P. M., æt. 40, was admitted on 18th April with a left irreducible inguinal hernia about the size of two fists. After repeated unsuccessful attempts at reduction by means of taxis, Dr. Cameron commenced treatment after a plan which he had seen pursued by Mr. Chiene of Edinburgh. A large pad of lint having been placed over the tumour and genital organs, a long bandage of elastic webbing was applied over the whole, passing spicafashion round both thighs, and crossing like a St. Andrew's cross in the perineum. Care was taken that it was not put on too tightly, but still sufficiently on the stretch to get the advantage of its elasticity. Only once was there pain complained of or any swelling of the scrotum caused, and yet the case is so far unfavourable for the treatment since the patient suffers from varicocele. The bandage has been removed morning and evening, and sometimes oftener, in order to allow the patient to make water, and he has latterly himself removed and reapplied it. He has, of course, been kept throughout strictly in the recumbent position. The result has been most satisfactory. The tumour rapidly decreased in size, until one day last week (May 30th) Dr. Cameron was able entirely to reduce it.

FROM DR. MACLAREN'S WARDS.

CHRONIC EAR DISEASE FOLLOWED BY SYMPTOMS OF CEREBRAL

AND SPINAL MENINGITIS.-Writing in the Glasgow Medical Journal for 1855, the late Dr. William Weir says:-" There are few medical practitioners who have not had under their care cases of purulent discharge from the ear, often continuing for a long time, and occasionally producing some headache, and more or less deafness. Such cases, as they may not be attended with much pain, and in many instances give rise to little inconvenience, are often not considered, either by the patient himself or by his physician, as of much consequence, and are hence allowed to go on for years, without any attempt being made to produce a perfect cure. It is well known, however, that cases of this kind are sometimes attended by very alarming symptoms, in consequence of the affection spreading from the ear to the brain, giving rise to inflammation and abscess, indicated by most severe pain in the head, more or less delirium, dimness of vision or total blindness, coma and death." He then gives an account of a case in point treated by him in the Royal Infirmary which, after a time, ended fatally. The relation between the two diseases, though well known, is apt

to be overlooked, and the following case, at present under Dr. Maclaren's care, may therefore be quoted as a reminder.

W. B., æt. 22, sailor, was admitted 29th April, 1879. When brought to the hospital, he seemed to be in a kind of stupor. He apparently understood little of what was said to him, and his answers were often unintelligible. In spite of this almost semi-comatose condition, he gave distinct enough evidence of suffering severe pain in his head by holding his hand to his brow, and moaning and crying like a child. In these circumstances, it was impossible to get a clear history of his case, but it was at length ascertained that, for the last two years, he had suffered from some affection of the left ear, brought on by a cold in the head, of which the only symptom attracting his attention was an almost constant, but very slight discharge. He paid little heed to it till a week or two before admission; while sailing from London to Glasgow, he began to get giddy, and fell two or three times, and this was soon followed by pain in the ear. He is sure that the giddiness was the first symptom. This, along with the pain, gradually increased, and a few days before admission, the latter had spread over the whole head. After this he can give no trustworthy account of himself. On the evening of his admission, the temperature in the axilla was 1014. The head was intensely hot, giving to the hand the impression of a much higher temperature. He could take some liquid food, but nothing solid, on account of the pain caused by chewing. The body was bathed in sweat, but the hands and feet rather cold. Bowels constipated. Ordered hot fomentations to the ear, and saline purgative. On 1st May, it was noted that he was very restless last night, being sometimes quite delirious. He is quieter to-day, but very dull and heavy, and still moaning, and complaining of the pain in his head. Pulse 72. Ordered bromide of potassium, 25 grs., thrice daily. Head to be shaved and ice-bag applied-fly blister to nape of neck. He slept better on the succeeding night, but still complained very much of the pain, which had now extended to the back of the neck. At the same time new symptoms appeared, evidently pointing to inflammation of the spinal meninges. The respiration became short, catching or spasmodie in character. There were frequent convulsive movements of the hands, and some rigidity of the muscles of the spine and back. There was no pain anywhere on steady pressure, but movements of the neck, shoulders, &c., were painful. There was occasional slight spasmodic contraction of the muscles of the face, causing an approach to the risus sardonicus. These last symptoms continued for a

He

day, coming and going, and then gradually passed off. still complained much of the pain in the head. On the 8th May, leeches were applied to the temples, and this was followed by very marked improvement. Since then he has continued to progress favourably, and for some time past, considerable restlessness at night has been the only noteworthy symptom. For that, he is still getting at bed-time grain of hydrochlorate of morphia by subcutaneous injection.

WESTERN INFIRMARY.

REPORTS UNDER THE SUPERVISION OF DR. W. G. DUN.

FROM DR. FINLAYSON'S WARDS.

SYPHILITIC HEMIPLEGIA-RECOVERY.-J. D., aged 24, was admitted on 25th February, 1879, complaining of partial loss of power in the right side, of five days' duration. On 20th February he suddenly felt giddy and stupid, his sight seemed to fail, and he experienced a prickling sensation in the right arm and leg, there was slight loss of power in both of those limbs, but he was able to remain at work as a baker all that day. Next morning he was unable to use the right arm, and he had some difficulty in walking. On admission to the Infirmary, four days later, he was observed to walk with an ungainly motion of the right leg, which hung loosely and was trailed a little. The right arm could perform most of the motions natural to it, but in a clumsy and feeble manner, the power of grasping was diminished, and patient required assistance in dressing and undressing himself. There was slight paralysis of the right side of the face, and the tongue deviated a little to the right when protruded. He had some difficulty in uttering certain words, such as "Complimentary," "February," &c., but no aphasic symptoms were present. He had been on the whole a tolerably healthy man. About eight months before his present illness he had contracted a chancre, from which he recovered in about two months; he suffered from sore throat slightly, but there had been no eruption except slight acne on the face; there was, however, some brown mottling over the abdomen, and there were rolling glands in the groin, and one or two could also be felt in the posterior triangle of the neck. There were no other signs of syphilis, no affection of the heart, and no albumen in the urine.

On the second day after admission patient was put upon the green iodide of mercury, 1 gr. thrice daily. Great improvement took place under this treatment, which was continued with but little interruption till the gums were touched, and thereafter it was reduced to 1 gr. daily. On 16th March the mercury was stopped, about 40 grs. in all having been given. From this date iodide of potassium was given, at first in doses of 5 grs., and then increased to 15 grs. thrice daily. On 27th March patient was dismissed, he was nearly well; but little unusual was observed in his gait, and the right hand had nearly recovered its accustomed power. A little thickness in his speech still remained. The use of the iodide of potassium was to be continued outside.

In view of the age of this patient and the absence of cardiac and renal disease, the diagnosis of syphilis seemed the most probable, and this was confirmed by the history of infection eight months previously, but the nervous symptoms seem to have occurred at an unusually early period in the disease.

A CASE OF TETANY-RECOVERY UNDER TREATMENT.—A. M., a tolerably healthy looking boy, aged 9, was admitted 10th May, 1879, complaining of a spasmodic affection of the arms and hands, specially of the thumbs, and also of the legs. The patient seems to have had perfectly good health till he was 3 years old, when, without any apparent cause, the spasms began, and they appear to have affected both the arms and legs at that time just as at present, but they were not quite so continuous, on some days being absent; the whole attack lasted only a fortnight. The illness was then supposed to be possibly connected with the irritation of the teeth. After this he seems to have had slight attacks off and on for about a year. A medical man who saw him at this time appears to have regarded the illness as being probably due to an affection of the glands of the bowels, this opinion being based on a tendency to diarrhoea, and on his general state. From that time up till about a year ago he had only slight attacks, lasting a day or two at a time, but it would appear that he was seldom more than perhaps six or seven months free from the attacks altogether, and his mother thinks there was a tendency to their occurrence in the winter time. About January, 1878, he had an attack lasting about a week, the spasms never going quite away during that time, and suffering frequent exacerbations. Since then, up till the beginning of the present attack, he has had frequent spasms of short duration, occurring specially, the mother thinks, in the morning when he awoke, lasting for